In an effort to halt the alarming decline in rural labor and delivery units across the country, Iowa Congressman Randy Feenstra introduced the Rural Maternity Options for Medical Support (MOMS) Act of 2026. The bipartisan legislation aims to remove regulatory hurdles that currently force small, rural hospitals to choose between maintaining maternity care or keeping their vital federal funding status.
Under current Medicare guidelines, facilities designated as Critical Access Hospitals (CAHs) are strictly capped at a maximum of 25 inpatient beds to qualify for enhanced federal reimbursement. Feenstra’s bill would update this rule by ensuring that beds dedicated exclusively to labor and delivery services do not count toward that 25-bed limit.
The technical adjustment addresses a growing crisis in rural healthcare, where a spike in local baby deliveries can inadvertently push a hospital over its federal bed limit, jeopardizing its entire financial structure. To avoid this regulatory trap, many rural hospitals have simply shuttered their obstetric wings altogether, creating vast “maternity deserts.”
Feenstra emphasized the real-world impact of these closures on families in his heavily rural district, noting that many expecting mothers are forced to drive over an hour just to access basic maternal care. He framed the legislation as a commonsense fix to stabilize local care options and ensure safer medical outcomes for rural families.
The measure has generated strong bipartisan support on Capitol Hill, with Representatives Darin LaHood (R-IL), Jill Tokuda (D-HI), and Kim Schrier (D-WA) all signing on as original cosponsors.
U.S. Representative Randy Feenstra (R-Hull)
Healthcare advocates in Iowa say the legislative fix could be a lifeline for the state’s remaining rural delivery rooms. Chris Mitchell, President and CEO of the Iowa Hospital Association, praised the bill for addressing a technical definition that carries immense real-world consequences, noting that keeping labor and delivery services close to home is paramount for the health of local moms and babies.
The bill has also picked up major national endorsements, earning backing from the American Hospital Association (AHA) and the National Rural Health Association (NRHA). Advocacy leaders noted that allowing higher-volume critical access facilities to maintain dedicated maternity beds—even when general inpatient beds are full—gives rural healthcare providers the operational flexibility necessary to put patient safety over bureaucratic red tape.
